Department of Oncology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.
Wuxi School of Medicine, Jiangnan University, Wuxi, China.
Front Immunol. 2023 Sep 11;14:1249980. doi: 10.3389/fimmu.2023.1249980. eCollection 2023.
The emergence of immunotherapy, particularly programmed cell death 1 (PD-1) and programmed cell death ligand-1 (PD-L1) produced profound transformations for treating non-small cell lung cancer (NSCLC). Nevertheless, not all NSCLC patients can benefit from immunotherapy in clinical practice. In addition to limited response rates, exorbitant treatment costs, and the substantial threats involved with immune-related adverse events, the intricate interplay between long-term survival outcomes and early disease progression, including early immune hyperprogression, remains unclear. Consequently, there is an urgent imperative to identify robust predictive and prognostic biological markers, which not only possess the potential to accurately forecast the therapeutic efficacy of immunotherapy in NSCLC but also facilitate the identification of patient subgroups amenable to personalized treatment approaches. Furthermore, this advancement in patient stratification based on certain biological markers can also provide invaluable support for the management of immunotherapy in NSCLC patients. Hence, in this review, we comprehensively examine the current landscape of individual biological markers, including PD-L1 expression, tumor mutational burden, hematological biological markers, and gene mutations, while also exploring the potential of combined biological markers encompassing radiological and radiomic markers, as well as prediction models that have the potential to better predict responders to immunotherapy in NSCLC with an emphasis on some directions that warrant further investigation which can also deepen the understanding of clinicians and provide a reference for clinical practice.
免疫疗法的出现，特别是程序性细胞死亡 1（PD-1）和程序性细胞死亡配体 1（PD-L1）的应用，为治疗非小细胞肺癌（NSCLC）带来了深刻的变革。然而，并非所有 NSCLC 患者在临床实践中都能从免疫治疗中获益。除了有限的反应率、高昂的治疗费用以及免疫相关不良反应带来的巨大威胁外，长期生存结果与疾病早期进展之间的复杂相互作用，包括早期免疫过度进展，仍然不清楚。因此，迫切需要识别强大的预测和预后生物标志物，这些标志物不仅有潜力准确预测 NSCLC 免疫治疗的疗效，还有助于识别适合个体化治疗方法的患者亚组。此外，基于某些生物标志物的患者分层的进展也可以为 NSCLC 患者的免疫治疗管理提供宝贵的支持。因此，在这篇综述中，我们全面检查了包括 PD-L1 表达、肿瘤突变负担、血液生物标志物和基因突变在内的个体生物标志物的现状，同时还探讨了联合生物标志物（包括影像学和放射组学标志物）以及预测模型的潜力，这些标志物可能更好地预测 NSCLC 患者对免疫治疗的反应，重点关注一些需要进一步研究的方向，这也可以加深临床医生的理解，并为临床实践提供参考。
